The avian flu virus hasn't yet managed to mutate into a form that can be efficiently transmitted from person to person, and we don't yet have a vaccine (since we don't know the precise form of virus we will be dealing with), but the experts all say that preparedness is the key to survival, and that includes getting straight on the ethical dimensions of preparedness. So along come Ezekial Emanuel and his co-author, Alan Wertheimer -- both of the Department of Clinical Bioethics, The Clinical Center (NIH) -- with a provocative suggestion for allocating inevitably scarce vaccine:

Science 12 May 2006: Vol. 312. no. 5775, pp. 854 - 855Policy Forum, PUBLIC HEALTH: Who Should Get Influenza Vaccine When Not All Can?

The potential threat of pandemic influenza is staggering: 1.9 million deaths, 90 million people sick, and nearly 10 million people hospitalized, with almost 1.5 million requiring intensive-care units (ICUs) in the United States. The National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Policy (ACIP) have jointly recommended a prioritization scheme that places vaccine workers, health-care providers, and the ill elderly at the top, and healthy people aged 2 to 64 at the very bottom, even under embalmers. The primary goal informing the recommendation was to "decrease health impacts including severe morbidity and death"; a secondary goal was minimizing societal and economic impacts. As the NVAC and ACIP acknowledge, such important policy decisions require broad national discussion. In this spirit, we believe an alternative ethical framework should be considered.

The alternative ethical framework: After front-line healthcare workers and vaccine production and distribution workers, preference goes generally to younger people over older, with a slight additional preference for key government leaders; public health, military, police, and fire workers; utility and transportation workers; telecommunications and IT workers; and funeral directors. Their rationale is complex and subtle and well worth reading. For those without access to Science, the Chicago Sun-Times has a pretty good article on this, as does Ceci Connelly at the Washington Post. [tm]